Healthcare Provider Details

I. General information

NPI: 1558686717
Provider Name (Legal Business Name): JOSEPH KOWAL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 DOVER RD SUITE B
CLARKSVILLE TN
37042-4144
US

IV. Provider business mailing address

351 DOVER RD SUITE B
CLARKSVILLE TN
37042-4144
US

V. Phone/Fax

Practice location:
  • Phone: 931-905-1001
  • Fax: 931-905-0410
Mailing address:
  • Phone: 931-905-1001
  • Fax: 931-905-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3084
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3182
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: